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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005495
Report Date: 07/26/2019
Date Signed: 08/09/2019 10:53:07 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:ALPHA KIDS ACADEMY LLCFACILITY NUMBER:
214005495
ADMINISTRATOR:BACHAKASHVILI, MAGDAFACILITY TYPE:
850
ADDRESS:1461 SOUTH NOVATO BLVDTELEPHONE:
(415) 664-8080
CITY:NOVATOSTATE: CAZIP CODE:
94947
CAPACITY:30CENSUS: DATE:
07/26/2019
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Magda Bachakashvili & Natella ShternTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Pandora Huffman-Smith met with the applicants, Magda Bachakashvili and Natella Shtern today for a follow up pre-licensing inspection. The purpose of today's inspection is to review required corrections prior to licensure.

The following items have been corrected:
  • Fire extinguisher has been installed
  • Rocks have been removed from the outdoor play area and cushioning was installed underneath the play structure.
  • Cubbies have been installed for children's belongings.
  • There is napping equipment for children.

**An LIC 184C, Notice of Incomplete Application, was issued to the applicants on 7/17/2019. LPA received a portion of the documents today.

The following is required prior to licensure:


  • Fire clearance.
  • Carbon monoxide detectors.
  • First aid supplies.
  • Facility postings.
  • LIC 503, Health Screening Report, with proof of measles immunization for the director.
  • Proof of completion of an EMSA approved CPR and first aid course for the director.
  • Proof of completion of the ECE Curriculum course for the director.
  • Proof of completion of mandated reporter training for both applicants.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Pandora Huffman-SmithTELEPHONE: (650)266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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